experience israel
EXPERIENCE ISRAEL WALK WHERE JESUS WALKED WITH PASTOR DAN CARROLL
APRIL 3 0 - MAY 10, 2 017
APPLICATION Completed applications (1 for each person) should be submitted to Water of Life Community Church Attn: Susan DePaola with checks made payable to International Heritage Tours. Last Name (as it appears on your passport):_________________________________________________________________________ First Name (as it appears on your passport):_________________________________________________________________________ Mailing Address:_________________________________________________________________________________________________ City:________________________________________________________________ State:___________ Zip Code: __________________ Day-Time Phone: ( Home Phone: (
)__________________________________________ )_____________________________________________
Birthdate (MM/DD/YYYY):______/______/________
Male
Female
E-mail Address:_________________________________________________ Emergency Contact:____________________________________________ Phone: (
)___________________________________________________
Room: I wish to room alone:________ (Single Supplement $939) or I wish to room with:_____________________________________ Passport #:_____________________________________________________ Expiration Date:________________________________________________ Please include a copy of all passports with deposit open to name and validity. If passport not available, please submit to Water of Life Community Church office Attn: Susan DePaola as soon as possible. I Would Like Insurance: Yes:______ No:______ If Yes, Travel Insurance must be paid for with the deposit. If No, Travel Insurance was offered but declined (signature required). Signature:_____________________________________________________ Enclosed payment of deposit $500.00 per person For:_______ persons @ $500 each
Total $_____________
Plus: $___________________ For Insurance
Total $_____________
Non-refundable payment in full is due by March 1, 2017. Rates include a 3% reduction for payment by check or money order, 3% surcharge applies to credit card payments. Credit card #:_____________________________ Expiration:___________ Name of Cardholder:____________________________________________ Signature of Cardholder:_______________________________________ Please include a clear copy of ID and both sides of the credit card.
We are not able to provide medical insurance. Please make sure to obtain travel insurance with medical coverage in your place of residence. The policy is Semi-Inclusive, with trip cancellation, lost luggage etc. IF YOU CLAIM, PLEASE STATE CLEARLY CLAIM IS IN US DOLLARS.
INSURANCE PREMIUMS FOR NON-MEDICAL TRAVEL INSURANCE For 1 person in a Double Room: Up to 59 years: 60 to 64 years: 65 to 69 years: 70 to 74 years: 75 to 79 years: 80 to 84 years:
$179 $207 $246 $283 $474 $611
For 1 person in a Single Room: Up to 59 years: 60 to 64 years: 65 to 69 years: 70 to 74 years: 75 to 79 years: 80 to 84 years:
$208 $244 $292 $337 $556 $720
APRIL 3 0 - MAY 10, 2 017
APPLICATION Completed applications (1 for each person) should be submitted to Water of Life Community Church Attn: Susan DePaola with checks made payable to International Heritage Tours. Last Name (as it appears on your passport):_________________________________________________________________________ First Name (as it appears on your passport):_________________________________________________________________________ Mailing Address:_________________________________________________________________________________________________ City:________________________________________________________________ State:___________ Zip Code: __________________ Day-Time Phone: ( Home Phone: (
)__________________________________________ )_____________________________________________
Birthdate (MM/DD/YYYY):______/______/________
Male
Female
E-mail Address:_________________________________________________ Emergency Contact:____________________________________________ Phone: (
)___________________________________________________
Room: I wish to room alone:________ (Single Supplement $939) or I wish to room with:_____________________________________ Passport #:_____________________________________________________ Expiration Date:________________________________________________ Please include a copy of all passports with deposit open to name and validity. If passport not available, please submit to Water of Life Community Church office Attn: Susan DePaola as soon as possible. I Would Like Insurance: Yes:______ No:______ If Yes, Travel Insurance must be paid for with the deposit. If No, Travel Insurance was offered but declined (signature required). Signature:_____________________________________________________ Enclosed payment of deposit $500.00 per person For:_______ persons @ $500 each
Total $_____________
Plus: $___________________ For Insurance
Total $_____________
Non-refundable payment in full is due by March 1, 2017. Rates include a 3% reduction for payment by check or money order, 3% surcharge applies to credit card payments. Credit card #:_____________________________ Expiration:___________ Name of Cardholder:____________________________________________ Signature of Cardholder:_______________________________________ Please include a clear copy of ID and both sides of the credit card.
We are not able to provide medical insurance. Please make sure to obtain travel insurance with medical coverage in your place of residence. The policy is Semi-Inclusive, with trip cancellation, lost luggage etc. IF YOU CLAIM, PLEASE STATE CLEARLY CLAIM IS IN US DOLLARS.
INSURANCE PREMIUMS FOR NON-MEDICAL TRAVEL INSURANCE For 1 person in a Double Room: Up to 59 years: 60 to 64 years: 65 to 69 years: 70 to 74 years: 75 to 79 years: 80 to 84 years:
$179 $207 $246 $283 $474 $611
For 1 person in a Single Room: Up to 59 years: 60 to 64 years: 65 to 69 years: 70 to 74 years: 75 to 79 years: 80 to 84 years:
$208 $244 $292 $337 $556 $720
